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AimTo describe salivary gland involvement in patients suspected of Sjögren’s syndrome (SS) using the OMERACT Ultrasound Scoring System for SS. Next, using different ultrasound cut-offs, to assess the performance of the scoring system for diagnosis and fulfilment of 2016 ACR/EULAR SS classification criteria.MethodsAll patients referred to our department with a suspicion of SS in a 12-month period were included. All underwent grey-scale ultrasound of the parotid and submandibular glands prior to clinical examination, Schirmer’s test, unstimulated salivary flow, blood samples including autoantibody analysis. Labial biopsy was performed according to clinicians’ judgement. Images of the four glands were scored 0–3 according to the scoring system and a consensus score was obtained using a developed ultrasound atlas.ResultsOf the 134 patients included in the analysis, 43 were diagnosed with primary SS (pSS) and all fulfilled the 2016 American College of Rheumatology (ACR)/EULAR classification criteria. More patients with pSS compared with non-pSS had score ≥2 in at least one gland (72% vs 13%; pConclusionThe OMERACT Ultrasound Scoring System showed good sensitivity (0.72) and excellent specificity (0.91) for fulfilling 2016 ACR/EULAR criteria using cut-off score >2 in at least one gland. Our data supports the use of ultrasound for diagnosing pSS and supports incorporation of ultrasound in the classification criteria.

Objective.The Tight Control of inflammation in Psoriatic arthritis (TICOPA; isrctn.com: ISRCTN30147736) trial compared standard care (StdC) and tight control (TC) in early psoriatic arthritis (PsA), demonstrating better outcomes for TC. This substudy evaluated the performance metrics of modern imaging outcomes and compared them to the clinical data.Methods.Non-contrast 0.2T magnetic resonance imaging (MRI; single hand) was assessed using the Outcomes in Rheumatology (OMERACT) PsA MRI Scoring System (PsAMRIS) with an additional global inflammation score. Ultrasound (US; same hand) was scored for greyscale, power Doppler, and erosions at the metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints and scores summated.Results.Seventy-eight patients had paired (baseline and 48 weeks) US data and 61 paired MRI data; 50 had matched clinical, MR, and US data. Significant within-group changes were seen for the inflammatory PsAMRIS components at MCP level: MRI global inflammation [median difference (range), standardized response mean (SRM)]: 3.25 (−5.0 to 12.0), 0.68; 1.0 (−4.5 to 17.5), 0.45 for TC and StdC, respectively. Similar within-group differences were obtained for US: 1.0 (−13.0 to 23.0), 0.45; 3.0 (−6.0 to 21.0), 0.77 for TC and StdC, respectively. No differences were seen between treatment groups. Significant correlations were found between baseline and change MRI and US scores. A significant correlation was found between baseline PsA disease activity scores and MRI global inflammation scores (Spearman ρ for MCP, PIP: 0.46, 0.63, respectively). No differences in erosion progression were observed.Conclusion.The PsAMRIS and US inflammation scores demonstrated good responsiveness. No between-group differences were demonstrated, but this substudy was likely underpowered to determine differences between the 2 treatment strategies.

Objective To evaluate low disease activity (LDA) cut-offs in psoriatic arthritis (PsA) using ultrasound. Methods Eighty-three PsA patients underwent clinical and ultrasound examinations at two visits. LDA was assessed using the Disease Activity index for Psoriatic Arthritis (DAPSA ⩽ 14), the Psoriatic ArthritiS Disease Activity Score (PASDAS ⩽ 3.2), the Composite Psoriatic Disease Activity Index ⩽ 4, the DAS28-CRP ⩽ 2.8 and the minimal disease activity criteria. Ultrasound was performed at 68 joints and 14 entheses. Minimal ultrasound disease activity (MUDA-j/e) was defined as a Power Doppler score ⩽ 1, respectively at joints, paratendinous tissue, tendons and entheses. A global ultrasound score was calculated by summing Grey Scale and Power Doppler information (GUIS-j/e). Results LDA was present in 33.7–65.0% at baseline and in 44.3–80.6% at follow-up, depending on the criteria used. MUDA-j/e was observed in 16.9% at baseline and in 30% at follow-up. GUIS-j/e was significantly higher in patients with moderate/high disease activity vs LDA according to DAPSA and PASDAS at baseline and DAPSA, PASDAS, Composite Psoriatic Disease Activity Index and minimal disease activity at follow-up. Patients in moderate/high disease activity had MUDA-j/e in 8.1–21.4% at baseline and in 8.3–20.0% at follow-up, depending on the applied clinical composite. MUDA-j/e patients with moderate/high disease activity had higher levels of pain and pain-related items than those with LDA. Conclusion The LDA cut-offs of DAPSA, PASDAS, Composite Psoriatic Disease Activity Index, minimal disease activity, but not DAS28-CRP are capable of distinguishing between high and low ultrasound activity. Pain and pain-related items are the main reason why PsA patients without signs of ultrasound inflammation are classified with higher disease activity.

BACKGROUND The aim of this pilot study was to evaluate the effects of Pycnogenol® and CA (Centellicum®) on penile fibrosis and on associated signs and symptoms. METHODS A group of 82 subjects with penile nodules and plaques was included in this registry study and followed up for 3 months; 32 were managed with standard management (SM) only. Twenty-four were managed with CA (Centellicum®: 3 capsules/day: 675 mg/day) in association with SM, and 26 subjects were managed with Pycnogenol® (150 mg/day) + CA (Centellicum® at the same dosage as in group 2) and SM. RESULTS Subjects in the 3 groups were comparable, including the distribution of plaques. The occurrence of any previous catheterizations was also comparable. Safety and tolerability were optimal, no subjects had to stop supplementation. The percentage of subjects with improved symptoms evaluated with a Visual Analogue Scale line was significantly higher with both supplements in comparison with SM (P

Middle turbinate head edema has recently been found to have high specificity for diagnosis of inhalant allergy. However, subtle mucosal edema can be difficult to appreciate under white light endoscopy. Narrow band imaging (NBI) has the potential to demonstrate edema by identifying reduced mucosal vascularity and improve sensitivity for the detection of mucosal edema. Narrow band imaging was assessed to determine its utility in objectifying mucosal edema.A cross-sectional diagnostic study was performed on patients with edematous mucosa of the middle turbinate head. Under traditional white light endoscopy, areas of edematous mucosa were identified. Using NBI, these areas were compared to areas of normal mucosa on the middle turbinate head. NBI images of these same areas were then converted to grey scale and a vascularity index was created by pixel analysis and brightness in Fiji Image J software (Wisconsin, US).Thirty-three middle turbinates were assessed (age 42.4 ± 12.5, 42.4% female). NBI discriminated between areas identified under white light endoscopy as edematous and normal (158.2 ± 48.4 v 96.9 ± 32.7 p 0.01). Receiver operating curve (ROC) analysis suggested a threshold of 115 brightness units to define endoscopically visible edematous mucosa with sensitivity 70% and specificity 79% (ROC AUC, p = 0.85).NBI can differentiate edematous from normal mucosa. The potential for an objective measure of mucosal edema may assist research efforts and may provide a more sensitive tool for subtle mucosal inflammatory changes.

Background Drug-eluting stents with biodegradable polymer coatings have shown promising outcomes in randomised studies. Methods We compared neointimal healing patterns including strut coverage and assessed neointimal maturity using a novel algorithm in coronary lesions treated with sirolimus-eluting stents with biodegradable polymer coating (BP-SES) or everolimus eluting stents with permanent polymer coating (PP-EES) using optical coherence tomography after 6months. Results A total of 39 patients were randomised to BP-SES ( n =19) or PP-EES ( n =20) for the treatment of coronary lesions. Of those, 29 patients (14 BP-SES and 15 PP-EES) underwent optical coherence tomography (OCT) and angiography at 6-month follow-up. Tissue coverage and apposition were assessed in a total of 6162 struts (BP-SES, n =2889; PP-EES, n =3273). Neointimal maturity was assessed in 3672 neointimal regions above struts using grey scale intensity analysis. OCT analysis showed neointimal coverage of 2433 (BP-SES) vs. 2702 (PP-EES) struts (84.2% vs. 82.6%, p =0.70), whereas the remainder was uncovered after 6months. Mean neointimal thickness did not differ significantly between groups (54.3±7.8μm vs. 80±14.6μm, p =0.12). The rate of malapposed struts was comparable between groups (1.3% vs. 2.2%, p =0.27). Grey scale signal intensity analysis showed mature tissue coverage of struts in 46.2% in BP-SES vs. 31.8% in PP-EES ( p =0.31) of neointimal regions. Conclusion The present study showed comparable early vascular healing response characterised by neointimal coverage with mainly immature neointima in both BP-SES and PP-EES.

SUMMARYThis work presents the multilayered caries model with a visuo-tactile virtual reality simulator and a randomized controlled trial protocol to determine the effectiveness of the simulator in training for minimally invasive caries removal. A three-dimensional, multilayered caries model was reconstructed from 10 micro-computed tomography (CT) images of deeply carious extracted human teeth before and after caries removal. The full grey scale 0-255 yielded a median grey scale value of 0-9, 10-18, 19-25, 26-52, and 53-80 regarding dental pulp, infected carious dentin, affected carious dentin, normal dentin, and normal enamel, respectively. The simulator was connected to two haptic devices for a handpiece and mouth mirror. The visuo-tactile feedback during the operation varied depending on the grey scale. Sixth-year dental students underwent a pretraining assessment of caries removal on extracted teeth. The students were then randomly assigned to train on either the simulator (n=16) or conventional extracted teeth (n=16) for 3 days, after which the assessment was repeated. The posttraining performance of caries removal improved compared with pretraining in both groups (Wilcoxon, p

To prospectively assess the diagnostic performance of supersonic shear wave elastography (SSWE) in identifying biliary atresia (BA) among infants with conjugated hyperbilirubinaemia by comparing this approach with grey-scale ultrasonography (US).Forty infants were analysed as the control group to determine normal liver stiffness values. The use of SSWE values for identifying BA was investigated in 172 infants suspected of having BA, and results were compared with the results obtained by grey-scale US. The Mann-Whitney U test, unpaired t-test, Spearman correlation and linear regression were also performed.The success rates of SSWE measurements in the control and study group were 100% (40/40) and 96.4% (244/253), respectively. Age, direct bilirubin, and indirect bilirubin all significantly correlated with SSWE in the liver (all P0.001). Linear regression showed that age had a greater effect on SSWE values than direct or indirect bilirubin. The diagnostic performance of liver stiffness values in identifying BA was lower than that of grey-scale US (area under the receiver operating characteristic curve [AUC], 0.790 vs 0.893, P0.001).SSWE is feasible and valuable in differentiating BA from non-BA. However, its diagnostic performance does not exceed that of grey-scale US.• SSWE could be successfully performed in an infant population. • For infants, the liver stiffness will increase as age increases. • SSWE is potentially useful in assessing infants suspected of biliary atresia. • SSWE is inferior to grey-scale US in identifying biliary atresia.

Purpose To investigate the interobserver agreement of different thyroid imaging report and data system (TI-RADS) and ultrasound (US) features. Methods Two researchers independently searched PubMed, Embase and the Web of Science for relevant studies published between October 1972 and December 2018. Studies investigating interobserver agreement between different radiologists were included. The Guidelines for Reporting Reliability and Agreement Studies (GRRAS) and the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) score tools were applied to assess the quality of the studies. The data for the inter-agreements of TI-RADS categories and ultrasound features were extracted, and combined with STATA 12.0 (StataCorp, College Station, TX) was used. Results Seven studies including 927 patients were eligible for this meta-analysis. There was a moderate variability in the TI-RADS categories among radiologists (0.54; 95% CI: 0.49−0.58). Regarding the US features, the reliability of composition (0.61; 95% CI: 0.55−0.66) and calcification (0.71; 95% CI: 0.65−0.77) was good, the reliability of echogenicity (0.58; 95% CI: 0.51−0.64), shape (0.53; 95% CI: 0.45−0.62), margin (0.40; 95% CI: 0.32−0.48) and echogenic foci (0.43; 95% CI: 0.32−0.54) was moderate. Subgroup analyses showed that experience/training, the number of observers and the number of patients were the main factors influencing the variability. Conclusions The interobserver agreement for the TI-RADS categories was moderate. There remains potential for improvement, especially in terms of the echogenicity, shape, margin and echogenic foci, the precision of the description and the targeted training needed.

Purpose Bifurcation stenting is thought to be associated with delayed healing and a subsequent risk of stent failure. The aim of this study was to further evaluate healing of thin-strut bioabsorbable polymer everolimus-eluting stents (EES) post bifurcation stenting by optical coherence tomography (OCT) including grey-scale signal intensity (GSI) analysis. Methods Patients undergoing bifurcation stenting with a planned two-stent approach using EES with OCT follow-up at 3–6 months post-stenting were included in this study. Morphometric analysis of contiguous cross-sections was performed at 1 mm longitudinal intervals within the stented segment. GSI analysis of neointimal regions of interest (ROI) overlying stent struts was performed for each of these cross-sections. Tissue coverage was classified as mature or immature. Results Data on a total of 31 lesions (17 cases) was available at a median of 168 days post stenting. Mean length of stented segments was 27.7 ± 16.6 mm. The mean minimum stent area was 6.50 ± 2.71 mm2 while the mean stent area was 8.69 ± 3.08 mm2. Amongst a total of 847 assessed frames, 9716 struts were visible. Overall strut coverage was 95.9%; 0.3% of struts were malapposed. The mean thickness of neointimal coverage was 100.95 ± 42.03 μm and the mean percentage area stenosis was 9.03 ± 7.80%. A total of 53.79% of ROIs were classified as mature. Conclusions After implantation of EES in bifurcation lesions, rates of uncovered and malapposed struts were low. GSI analysis showed that more than half of neointimal areas analyzed were classified as mature in keeping with advanced vessel healing.

Objectives To investigate the diagnostic performance of grey scale Ultrasound (US), power Doppler (PD) and US elastography for diagnosing painful patellar tendinopathy, and to establish their relationship with Victorian Institute of Sport Assessment-Patella (VISA-P) scores in a group of volleyball players with and without symptoms of patellar tendinopathy. Design Cross-sectional study. Methods Thirty-five volleyball players (70 patellar tendons) were recruited during a national university volleyball competition. Players were imaged with conventional US followed by elastography. The clinical findings of painful patellar tendons were used as the reference standard for diagnosing patellar tendinopathy. In addition, all participants completed the VISA-P questionnaires. Results Of the 70 patellar tendons, 40 (57.1%) were clinically painful. The diagnostic accuracy of grey scale US, PD and elastography were 60%, 50%, 62.9%, respectively, with sensitivity/specificity of 72.5%/43.3%, 12.5%/100%, and 70%/53.3%, respectively. Combined US elastography and grey scale imaging achieved 82.5% sensitivity, 33.3% specificity and 61.4% accuracy while routine combination technique of PD and grey scale imaging revealed 72.5% sensitivity, 43.3% specificity and 60.0% accuracy. Tendons in players categorized as soft on elastography had statistically significantly greater AP thickness ( p p =0.004) than those categorized as hard. There was no significant association between grey scale US abnormalities (hypoechogenicities and/or fusiform swelling) and VISA-P scores ( p =0.098). Conclusions Soft tendon properties depicted by US elastography may be more related to patellar tendon symptoms compared to grey scale US abnormalities. The supplementation of US elastography to conventional US may enhance the sensitivity for diagnosing patellar tendinopathy in routine clinical practice.

Introduction: Elastrography used in addition to grey scale sonography increases its specificity. Elasticity contrast index (ECI) is based on strain elastrography and being a quantitative parameter, maybe more easy to obtain and reproducible while researches has been done in ECI in thyroid lesions, this is the first study, to the best of our knowledge to evaluate in breast lesions. This study was done to evaluate the diagnostic accuracy of Elasticity Contrast Index (ECI) in differentiating benign from malignant lesions of breast and to determine its cutoff value. Methods: This is a descriptive cross-sectional study done at tertiary health care centre, which involved retrospective evaluation of data collected from September 2016 to March 2017. Conventional sonography was done followed by elastography on commercially available ultrasound machine. ECI was calculated in thyroid protocol available in the unit. Histopathological diagnosis was obtained for all the lesions and taken as gold standard. Results: A total of 89 breast lumps were evaluated, of which was 61 (69.3%) were benign and 27 (30.7%) malignant on histopathology. Independent t test revealed the average ECI value of benign lesions was 2.48 and malignant 5.1. Receiver operating curve showed ECI value of 3.25 as the cutoff, above which the lesions were malignant. Conclusions: ECI is a quantitative elastography technique which can be easily used as an adjunct during breast sonography and can increase its specificity for diagnosing a lesion as malignant. This could reduce the number of false positive biopsies.

To assess the effectiveness of grey-scale and colour Doppler ultrasound (US) versus magnetic resonance imaging (MRI) for the prenatal diagnosis of placenta accreta.A prospective observational study including a total of 74 patients with placenta previa and previous uterine scar (n = 74). Grey-scale and colour Doppler US was done followed by MRI by different observers to diagnose adherent placenta. Test validity of US and MRI were calculated. Maternal morbidity and mortality were also assessed.A total of 53 patients confirmed to have placenta accreta at operation. The overall sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of US was 94.34, 91.67, 96.15 and 88% compared to 96.08, 87.50, 94.23 and 91.3% for MRI, respectively. The most relevant US sign was turbulent blood flow by colour Doppler, while dark intra-placental band was the most sensitive MRI sign. Venous thromboembolism (1.3%), bladder injury (29.7%), ureteric injury (18.9%), postoperative fever (10.8%), admission to ICU (50%) and re-operation (31.1%).Placenta accreta can be successfully diagnosed by grey-scale and colour Doppler US. MRI would be more likely suggested for either posteriorly or laterally situated placenta previa in order to exclude placental invasion.

Grey scale ultrasound (US) is the first line imaging modality used for the evaluation of liver by the radiologists and clinicians worldwide. It is a simple, inexpensive, safe and an easily available technique. US has the ability to delineate the hepatic parenchyma and differentiate the cystic from solid hepatic lesions. However, it has limited accuracy in the detection and characterization of focal liver lesions (FLL). CEUS is a major breakthrough in ultrasound imaging which evolved with the aim of overcoming these limitations of US. With the use of ultrasound contrast agents (UCAs), CEUS has the ability to detect the intranodular hemodynamics and thereby provide information of the enhancement pattern of the lesion resulting in reliable characterization of the FLL. This capability brings it at par with the cross sectional contrast enhanced imaging techniques of computed tomography and magnetic resonance imaging. UCAs are safe, non-nephrotoxic and thus can be used to evaluate patients with renal failure as well. The technique of CEUS is simple, requires few minutes to perform, portable, lacks ionising radiation and above all is a cost-effective modality. These advantages have made CEUS an established modality for hepatic imaging. Besides detection and characterization of FLL, it also plays a vital role in the management and repeated follow up of treated patients of FLL. Newer clinical applications of CEUS with promising results are also being unravelled . This review highlights the multifaceted role of CEUS in hepatic imaging and its upcoming clinical applications.

The use of ultrasound (US) has been at the forefront of aiding diagnosis of inflammatory arthritis since its introduction. More recently, US imaging in patients with clinical remission appears to provide prognostic information with respect to disease flares and progression.1 2 Ultrasonographic scoring typically uses a semiquantitative scale of 0–3 for synovial hypertrophy (SH) and power Doppler (PD). This system works very well in smaller joints or those with single articulations. However, in complex joints such as the wrist with many articulations, the final grading can be difficult. Figure 1A illustrates three potential positions used to score wrist synovitis. As a consequence, there are a number of possible permutations for the wrist US score. Figure 1 (A) Illustration of wrist US probe positions and corresponding US images, used for US wrist assessment. (B) Fisher’s exact statistical testing for association between high and low SH/PD groups compared with high and low Krenn synovitis scores. The high US SH score is denoted by …

Purpose Fatty liver infiltrations and fatty sparing impair diagnostic performance of grey-scale ultrasonography in differentiating malignant and benign focal liver lesions. In the study, we present our experience in diagnosing focal fatty liver infiltrations and focal fatty sparing with contrast-enhanced ultrasonography (CEUS) in comparison to grey-scale ultrasonography and contrast-enhanced computed tomography (CECT). Material and Method The retrospective study group (n=82 patients), included 44 (53.7%) men, 38 (46.3%) women (aged 29–81 years, mean 55.8 years) with 48 focal fatty liver infiltrations and 34 focal fatty sparing. All patients underwent grey-scale ultrasonography (US), CEUS using SonoVue ® and CECT executed within the 7 days. Results With US, CEUS and CECT focal fatty liver infiltrations were diagnosed in 22, 46 and 44 cases, respectively. The following values were obtained: sensitivity − 45.8%, 95.8% and 91.7%, specificity − 100% for all, accuracy − 95.2%, 99.6% and 99.3%, respectively. Focal fatty sparing was diagnosed in 16, 31 and 30 cases, respectively. The following values were obtained: sensitivity − 47.1%, 91.2% and 88.2%, specificity − 99.8%, 100% and 100%, accuracy − 95.6%, 99.4% and 99.3%, respectively. No statistically significant differences were found in sensitivity of diagnosing focal fatty liver infiltrations and focal fatty liver sparing between CEUS and CECT. Sensitivity of grey-scale ultrasonography was significantly lower when compared to those of CEUS and CECT (p Conclusion CEUS is as sensitive as CECT in focal fatty infiltrations and focal fatty sparing diagnosing. However, CEUS provides more information than CECT about the vasculature and enhancement pattern of focal fatty liver infiltrations.

BackgroundThere is a lack of standardized echocardiographic parameters to quantify ventricular function in newborn infants. Long-axis systolic ventricular shortening is a useful parameter of global ventricular function.AimsSerial assessment of long-axis systolic atrioventricular annulus excursion in premature infants.MethodsTwo-centre, prospective observational study. Fifty-seven premature infants (26 girls), median (range) gestational age 33+5 (310–34+6) weeks+days, birth weight 1925 (1127–2836) grams were included. Echocardiographic examinations were performed at the first three days of life and at expected term.Outcome measuresSystolic annulus excursion by grey-scale m-mode and colour tissue Doppler imaging (cTDI).ResultsA consistent longitudinal pattern was found for annulus excursion by grey-scale m-mode and cTDI. All parameters showed a pronounced increase at expected term (p

Microbubbles (MBs) are gas-filled hollow microparticles. Under the ultrasound field, the difference of acoustic characteristics between gas and plasma in the blood vessel will cause strong impedance mismatch and echogenicity to enhance ultrasonic grey scale imaging. The linear or nonlinear resonance of MB shell in the ultrasound field would lead to repeated expansion-contraction till destruction. In this case, the pre-loaded drug in the MB shell will be released in an accelerated manner triggered by the ultrasound at a probe-given site. Sonoporation effect of the cell membrane would also help increase the uptake of substances into cells. This paper is dedicated to review recent developments on MBs, especially multifunctionalized MBs, as a potential drug/gene delivery microdevices for both diagnosis and therapy of malignant tumors.

Musculoskeletal ultrasound is an increasingly used tool for the evaluation and management of rheumatologic diseases. Its utilisation by rheumatologists is varied around the world and is dependent upon training and local expertise. Its applications can be broadly categorised into three main areas; for the education of patients, to aid the rheumatologist in the diagnosis and monitoring of disease, and therapeutically for joint aspiration and injection. Ultrasound is a safe, portable, easily repeatable, dynamic images in multiple planes and cheap form of imaging. Ultrasound however, is operator dependent and has a number of artefacts that can result in misinterpretation. Musculoskeletal Ultrasound uses a number of modes to characterise joint pathology, including grey scale, colour and power Doppler, spectral Doppler, 3D imaging, elastography. Musculoskeletal ultrasound can detect and monitor multiple joint pathologies including synovitis, tenosynovitis, and tendon pathologies, entheseal processes, bone erosions and osteophytes, cartilage changes and bursal pathologies.

To determine the sonographic criteria for diagnosis of fetal intracranial hemorrhage (ICH), using both gray scale ultrasound, and tomographic ultrasound imaging (TUI).A prospective multicenter study, recruiting patients at risk of fetal ICH over four years. All cases with fetal ICH had serial ultrasound assessments, including TUI, fetal and postnatal MRIs.Twenty-one patients were diagnosed with fetal ICH, two cases had extracerebral (subdural) hemorrhage, 16 cases had intracerebral (intraventricular) hemorrhage and three cases had combined hemorrhage. The mean gestational age at which they were diagnosed was 29.8 ± 5.2 weeks. Seventy-six percent of cases had no identifiable risk factors. IUGR was associated with 57.9% of cases. Using grey scale ultrasound, we demonstrated clear cut sonographic criteria for diagnosis of fetal ICH. TUI enabled us to detect some midline cerebral lesions not detected by grey scale 2D ultrasound alone. Fetal and postnatal MRI confirmed those findings.Ultrasonography can be used in the detection, classification and monitoring the progression of various types of ICH. TUI is an additional diagnostic tool that might help to detect the exact size, and extent of those lesions. Fetal MRI is not superior, but might aid in the diagnosis.

Conventional ultrasonographic evaluation (grey scale and Doppler) represents the first line investigation in the acute pathology of the scrotum. Its diagnosis value in acute scrotal pathology is undoubted in regard with hypervascular lesions, but in the evaluation of isoechoic and hypo/avascular lesions i.v. contrast-enhanced harmonic ultrasonography (CEUS) is recommended in establishing a firm and certain diagnosis. Besides these, CEUS has an important role in the evaluation of the remaining viable testicular tissue in cases of testicular trauma, thus guiding a limited excision surgery. This paper aims to discuss the added diagnosis value of CEUS and to illustrate this through various ultrasonographic images suggestive for acute scrotum pathology.

Doppler ultrasound scanning is the first line investigation for quantifying the internal carotid artery stenosis. Nevertheless, the lack of internationally accepted ultrasound criteria for describing the degree of stenosis has contributed to the different and confusing measurements ranges. The use of two different angiographic methods, the North American Symptomatic Carotid Endoarterectomy Study and the European Carotid Surgery Trial was probably the major initial source of confusion in deriving valid and reliable duplex ultrasound criteria worldwide. The consensus proposed in 2003 by the Society of Radiologists in Ultrasound has been a great attempt to create a conformity document, establishing grey scale and Doppler criteria in considering the different degrees of stenosis. According to this attempt, in 2010, the multi-parametric Deutsche Gesellschaft für Ultraschall in der Medizin ultrasound criteria have been proposed with a precise differentiation between main and additional criteria and depicted a different peak systolic velocity (PSV) threshold. In 2012, these criteria have been implemented, focusing on the multi-parametric approach, re-defining the PSV values and clearly introducing the concept of PSV average. Despite these attempts, a wide range of practice patterns still exists, with consistent disparities in patients' care. This paper collects these previous experiences and summarizes their strengths and weaknesses, to give a contribution in the carotid artery stenosis grading standardization using ultrasonic methods. Carotid ultrasound as the only diagnostic tool for the selection of patients for carotid surgery or stenting will be possible only with internationally accepted criteria.L’eco-color Doppler dei tronchi sovra-aortici rappresenta la metodica non invasiva d’eccellenza per quantificare le stenosi carotidee. Tuttavia, la mancanza di criteri ultrasonografici di quantificazione del grado di stenosi universalmente accettati genera dati confondenti, spesso non equiparabili, con conseguente disparità di diagnosi, trattamento e costi. L’origine del dibattito ha avuto verosimilmente inizio a seguito della pubblicazione dei due maggiori trials angiografici, l’americano (NASCET) e l’europeo che definivano la quantificazione percentuale della stenosi dell’ arteria carotide interna in maniera oggettivamente differente. Il documento di consenso del 2003 della Society of Radiologists in Ultrasound è stato il primo tentativo di standardizzazione dei criteri, prendendo posizione sui valori soglia di velocità del picco sistolico nella quantificazione della stenosi e considerando come riferimento il metodo NASCET. Nel 2010, la Società Tedesca di Ultrasonologia (Deutsche Gesellschaft für Ultraschall in der Medizin, DEGUM), ha proposto un approccio di quantificazione multi-parametrico con percentuali di graduazione più definite e con differenti valori soglia di velocità rispetto alla proposta precedente prendendo in considerazione valori di velocità di picco sistolico (PSV) di 200 cm/s rispetto a PSV di 125 cm/s per stenosi NASCET del 50 %. Un’ ulteriore nuova proposta classificativa, comparsa sulla rivista

Intravascular ultrasound has done much to improve our understanding of atherosclerosis and the impact of percutaneous intervention on the coronary artery. However, subjectivity in interpreting the acoustic reflection of the ultrasound signal has spawned the development of other progressive technologies. Virtual histology intravascular ultrasound (VHIVUS) utilises the ultrasound backscatter signal in order to colour code plaque into four pre-specified subtypes based on their histological composition. We review the background behind traditional grey scale intravascular ultrasound (IVUS) and examine the current evidence for VHIVUS and its potential for use in clinical interventional practice.

Based on grey language multi-attribute group decision making, a kernel and grey scale scoring function is put forward according to the definition of grey language and the meaning of the kernel and grey scale. The function introduces grey scale into the decision-making method to avoid information distortion. This method is applied to the grey language hesitant fuzzy group decision making, and the grey correlation degree is used to sort the schemes. The effectiveness and practicability of the decision-making method are further verified by the industry chain sustainable development ability evaluation example of a circular economy. Moreover, its simplicity and feasibility are verified by comparing it with the traditional grey language decision-making method and the grey language hesitant fuzzy weighted arithmetic averaging ( G L H W A A ) operator integration method after determining the index weight based on the grey correlation.

Background Attempts to stratify carotid plaques according to clinical risk using single longitudinal view (SLV) echomorphology have not been uniformly successful. We compared SLV grey scale median measurements (SLV-GSM) with a newer technique of multiple cross-sectional view echomorphology (MCSV-GSM) in carotid plaques from 3 patient groups (asymptomatic, ocular, and hemispheric symptoms). Methods SLV and MCSV images were obtained from 109 carotid stenoses (70–99%; 41 hemispheric, 17 ocular, 51 asymptomatic). SLV-GSM and MCSV-GSM min (lowest plaque MCSV image GSM) were determined to assess echolucency whilst MCSV-GSM max−min (highest minus lowest MCSV-GSM) assessed heterogeneity. Results Echolucency was greater (lower GSM) in plaques causing hemispheric symptoms versus asymptomatic plaques (MCSV-GSM min , P = .002; SLV-GSM, P = .002). Only MCSV imaging detected differences in echolucency between asymptomatic plaques and those causing ocular symptoms (SLV-GSM, p = 0.84; MCSV-GSM min , p = .003). Symptomatic plaques showed greater heterogeneity versus asymptomatic plaques, significantly in those causing ocular symptoms (hemispheric P = .126; AF P = .011). Conclusions Both SLV and MCSV echomorphology confirm increased echolucency in plaques causing hemispheric symptoms. Plaques causing ocular symptoms could only be distinguished from asymptomatic plaques with MCSV assessment (increased echolucency and heterogeneity). This suggests that amaurosis fugax may be associated with a more focal plaque instability that is best detected with MCSV imaging.

Aim: To determine whether colour or grey-scale images from high-resolution spectral optical coherence tomography (OCT) are superior in visualising clinically important details of retinal structures. Methods: Patients with macular pathologies were imaged using spectral OCT (OTI, Toronto, Canada). Two reviewers independently analysed the retinal structures and pathologies and graded them on a four-point scale on the basis of the visibility. A third reviewer masked to the results then reviewed images where there was a different score for colour versus grey scale. Results: Statistical analysis showed the grey-scale image to be significantly better in visualising the details of epiretinal membrane, photoreceptor and retinal pigment epithelium layer morphology than the colour scale image (p = 0.00088–0.0006). In 16.17% of eyes, the colour image led to the false impression of photoreceptor disruption. Conclusion: Grey-scale images are qualitatively superior to the colour-scale images on high-resolution spectral OCT. Colour images can be misleading, as the displayed colours are false colours, and the observer may see a dramatic change in colour and interpret that as a large change in the OCT reflectivity.

The purpose of this laboratory study was to assess the potential cleaning efficacy of nine different toothbrushes around brackets in vitro. Standard and Mini Diamond™ brackets were fixed on coloured teeth in a special model, coated with white titanium oxide, brushed in a machine with different manual toothbrushes (three different types: planar, staged, and v-shaped bristle field), and tested with a horizontal motion for 1 minute. After brushing, the teeth were scanned and the black surfaces were planimetrically assessed using a grey scale. Tooth areas which were black again after brushing indicated tooth surface contact of the filaments. The remaining white tooth areas around the brackets indicated ‘plaque-retentive' niches. Statistical analysis was carried out using the Kruskal-Wallis one-way test of variance for individual comparison. Bonferroni adjustment was used for multiple testing, and comparison of bracket size with Wilcoxon signed rank test. In the most critical area of 2 mm around the brackets, there was no statistically significant difference between the different toothbrushes evaluated. The untouched area ranged from 11 to 26 per cent of the initially whitened tooth surface. By pooling the toothbrushes according to their design, the median cleaning efficacy of the v-shaped (73.1 per cent) and staged (75.6 per cent) toothbrushes resulted in significantly superior cleaning efficacy than planar toothbrushes (60.7 per cent) for standard brackets. For mini bracket type, staged toothbrushes showed a significantly better mean cleaning efficacy (77.8 per cent) than planar (65 per cent) and v-shaped (72.4 per cent) toothbrushes. Staged and v-shaped brush designs resulted in superior cleaning efficacy of teeth with fixed orthodontic attachments than toothbrushes with a planar bristle field. None of the tested toothbrushes showed a consistent, significantly higher cleaning efficacy than the others in this in vitro experiment

Cone-beam CT (CBCT) images have recently become an established modality for treatment verification in radiotherapy. However, identification of soft-tissue structures and the calculation of dose distributions based on CBCT images is often obstructed by image artefacts and poor consistency of density calibration. A robust method for voxel-by-voxel enhancement of CBCT images using a priori knowledge from the planning CT scan has been developed and implemented. CBCT scans were enhanced using a low spatial frequency grey scale shading function generated with the aid of a planning CT scan from the same patient. This circumvents the need for exact correspondence between CBCT and CT and the process is robust to the appearance of unshared features such as gas pockets. Enhancement was validated using patient CBCT images. CT numbers in regions of fat and muscle tissue in the processed CBCT were both within 1% of the values in the planning CT, as opposed to 10-20% different for the original CBCT. Visual assessment of processed CBCT images showed improvement in soft-tissue visibility, although some cases of artefact introduction were observed. © 2008 Institute of Physics and Engineering in Medicine.

To evaluate the correlation of grey-scale and colour Doppler sonography with colonoscopy and histology to detect bowel inflammation in children.The records of 72 patients with suspected bowel inflammation were reviewed retrospectively. Patients were included in the study if sonography had been performed up to 30 days before colonoscopy. Grey-scale and colour Doppler sonography were used to evaluate bowel wall thickness and vascularity for the detection of distal bowel inflammation. Findings were correlated with colonoscopy and histological findings. The sensitivity and specificity of sonographic wall thickness to detect inflammation was determined. Spearman's coefficient (rs) was used to determine the correlation of Doppler findings with colonoscopy/histology.Sonograms of 372 bowel segments were evaluated and results were correlated with colonoscopy and histological findings of 352 segments. The sensitivity and specificity of sonographic bowel thickness to detect inflammation in the terminal ileum and the right colon were high; in the other segments, specificity was high but sensitivity was low. The correlation of Doppler sonography with colonoscopy and histology to detect inflammation in the terminal ileum was strong (rs: 0.84; p0.001) and in the other segments, weak to moderate; when the interval between examinations was shorter than 10 days, the correlation was stronger in all segments. Of nine patients with abnormal small bowel sonograms but normal colonoscopies, three had Crohn's disease.Sensitivity and specificity of grey-scale sonography to detect inflammation in the terminal ileum and the right colon were high, and the correlation of Doppler with colonoscopy and histology was very strong in the same segments.

Alignment of the CBCT with the reference CT is called image registration (IR). The parameters for utilizing the automated Elekta XVI IR software for IGRT of the prostate still remain to be defined. In this study, we compare several automated XVI IR parameters to manual registration to identify the optimal automated IR technique for the prostate gland. 280 prostate IRs were conducted as follows: 210 automated, and 70 manual IR were performed using 70 CBCT scans of seven patients. The three arms of the automated registrations were: (i) extended FOI/Bone + grey scale (double IR); (ii) limited FOI/GS (single IR); and (iii) extended FOI/GS (single IR). Automated IRs were compared to manual IRs; x, y, z shifts, failures, and errors recorded for off-line analysis. Based on the most successful parameters, a departmental protocol was developed and 432 automated IR were performed (on 20 patients) for analysis. Automated IR were classified as: Successful, failed, error, or unregistered. In arm 1, the rate of successful, failed, error, and unregistered IR were 52.8%, 1.5%, 8.6%, 37.1%, respectively, arm 2: 90% successful, 10% failed, arm 3: 100% successful. Using the arm 3 parameters for the 432 automated IRs, the incidence of unregistered scans was 0%, rescanning was required in 1% of treatments, and the time for performing the auto IR was < 5.5 minutes. We found that extended FOI + single (GS) IR results in shifts comparable to manual IR using automated XVI software. We experienced multiple unsuccessful registrations with the other methods. We conclude that when utilizing the Elekta XVI automated IR software, the extended FOI/single IR results in successful registrations most often. In addition, it is currently effectively used in our clinical practice.

Objectives To determine whether ultrasound can identify anti-cyclic citrullinated peptide (anti-CCP) antibody-positive patients without clinical synovitis (CS) who progress to inflammatory arthritis (IA). Methods In a prospective study, anti-CCP-positive patients without CS underwent ultrasound imaging of 32 joints (wrists, metacarpophalangeal joints, proximal interphalangeal joints and metatarsophalangeal joints (MTPs)) and were monitored for the development of IA. Associations between baseline ultrasound findings (grey scale (GS), power Doppler (PD) and erosions) and (1) progression to IA and (2) development of CS within an individual joint were measured. Results Consecutive anti-CCP-positive patients (n=136; mean age 51 years, 100 women) were followed up for median of 18.3 months (range 0.1–79.6). At baseline 96% had GS, 30% had PD and 21% had one or more erosions. IA developed in 57 patients (42%) after median of 8.6 months (range 0.1–52.4). Ultrasound abnormalities (GS ≥2, PD ≥1 or erosion ≥1) were found in 86% at baseline compared with 67% of non-progressors (χ 2 =6.3, p=0.012). Progression to IA was significantly higher in those with ultrasound findings in any joint (excluding MTPs for GS) (GS ≥2: 55% vs 24%, HR (95% CI) 2.3 (1.0 to 4.9), p=0.038; PD ≥2: 75% vs 32%, 3.7 (2.0 to 6.9), p Conclusion Ultrasound features of joint inflammation may be detected in anti-CCP-positive patients without CS. Ultrasound findings predict progression (and rate of progression) to IA, with the risk of progression highest in those with PD signal. Trial registration number NCT02012764; Results.

Contrast enhanced ultrasonography, using IV and/or oral/rectal contrast agents, represents a technical development of the US method, which has proved its applicability in the qualitative and quantitative assessment of the normal and pathological circulatory bed, as well as of the digestive lumen. The use of microbubbles and harmonics opens a new horizon in the detection and characterization of the inflammatory and tumoral conditions of the digestive tract. The interpretation of the data requires corroboration with the grey scale aspect of the examined lesion/area, as well as with the clinical context of the case and the results of other diagnosis techniques. The purpose of this paper is to review the main applications of CEUS in digestive tract pathology by analyzing the significant literature and guidelines in the light of our personal experience and demonstrating it through suggestive images.

Two experiments were performed to relate the Bezold-Brücke (B-B) and lightness compression effects. The first used a calibrated screen to present an achromatic luminance staircase. In addition, it reproduced, the methodology and the essential aspects the lightness compression effect discovered by Cataliotti and Gilchrist (1995). That is, observers perceived a truncated grey scale (from white to medium grey) when the staircase was the only stimulation in the near background (Gelb condition), but not when presented on a Mondrian background, because of the high articulation level provided by this background. Experiment 1 design also included two other backgrounds that produced a partial compression effect. In Experiment 2, two chromatic staircases were used. Employing a naming task, changes in hue perception were only observed for the susceptible staircase. The observed changes were of two types. First, for the full staircase presentations, a Gelb background produced maximum lightness compression (more similarity in the lightness of the staircase stimuli) and, also, a minimum B-B effect (fewer differences in hue). Second, only for the Gelb condition, there were changes in the hue of the lowest luminance staircase stimuli depending on the staircase extension. Results are discussed in the framework of the anchoring theory of lightness perception.

Ultrasonography (US) is the essential imaging method in gallbladder examination being the most widespread and inexpensive technique. The method is indicated both in congenital and acquired disorders, inflammatory, tumoral, or degenerative pathology. Besides the basic technique (grey scale US), new sophisticated techniques exist: Doppler US, i.v. contrast enhanced harmonic examination, tridimensional US, elastography. Each technique provides specific information, while their combination helps, in most cases, to establish the accurate non-invasive diagnosis. However, the US findings should be correlated with the patient's clinical exam and other imaging methods. This paper is a synthesis of literature combined with our own experience, aiming to present the US features of gallbladder pathology and the correlations within the clinical picture and other imaging methods. Relevant images for this integrative approach are presented. The final conclusion is the necessity for a correlation of all clinical and imaging data in order to obtain an accurate diagnosis.

This work investigates public perception of the blackening of light coloured stone historic buildings in some European countries. It used on-site questionnaires to explore the perceived lightness of the façades in terms of opinions that the building is dirty or needs cleaning. There was a clear relation between opinions about the dirtiness of a building and views that it should be cleaned. Visitors to buildings found the assignment of colour or a grey scale value to buildings relatively easy despite the fact that they are typically made up of many shades. There was a strong relationship between the perceived lightness of a building and the opinion that it was dirty. This relationship was used to establish potential levels of blackening that may be publicly acceptable and propose some aesthetic thresholds. Such thresholds suggest approaches to setting limit values for elemental carbon in the air, such that significant buildings do not become unacceptably discoloured. Developments of this kind contribute to the regulation of non health aspects of air pollution and aid decision making in the management of significant buildings.

The use of grey scale prostate ultrasound decreased after the implementation of magnetic resonance imaging (MRI) for the diagnosis and evaluation of prostate cancer. The new developments, such as multiparametric ultrasound and MRI-ultrasound fusion technology, renewed the interest for this imaging method in the assessment of prostate cancer. The purpose of this paper was to review the current role of prostate ultrasound in the setting of these new applications. A thorough reevaluation of the selection criteria of the patients is required to assess which patients would benefit from multiparametric ultrasound, who wouldbenefit from multiparametric MRI or the combination of both to assist prostate biopsy in order to ensure the balance between overdiagnosis and underdiagnosis of prostate cancer.

The aim of this study was to identify ultrasonic tissue characteristics and stenosis of carotid plaques that correspond to amaurosis fugax, hemispheric transient ischaemic attack, and stroke. At total of 146 symptomatic carotid plaques (136 patients) associated with amaurosis fugax, hemispheric transient ischaemic attack, stroke, and having 50–99% stenosis on duplex, were studied. These plaques were imaged on duplex, captured in a computer and their grey scale median was evaluated to distinguish the dark (low grey scale median) from the bright (high grey scale median) plaques. Stenosis was assessed on duplex. The amaurosis fugax group corresponded to carotid plaques with low grey scale median and severe stenosis, as contrasted with the other two groups (hemispheric transient ischaemic attacka and stroke) (P

Giant cell tumor is among the rare tumors of the bone. We present a case of metacarpal giant cell tumor with radiographic, computed tomographic (CT) and histologic findings, as well as grey scale and Doppler sonographic features. We also present the "doughnut"-shaped appearance on scintigraphy of the lesion, which has not been shown on a metacarpal giant cell tumor.

The stimulable phosphor plate technique has revolutionised radiology with portable equipment. The image quality permits diagnosis under difficult control conditions (ICUs). In order to achieve a signal-to-noise ratio, and therefore a contrast resolution similar to the commonly used film/screen systems, a higher radiation dose is needed. However, overall, with this technique a radiation dose reduction may be achieved as a result of the elimination of the need for retakes. The available stimulable phosphor plate systems, with adequate image processing are reliable, and at least as good as conventional film/screen systems for diagnosis in chest radiography. There are, however, other aspects that make the stimulable phosphor plate technique particularly appealing. Firstly, its reproducibility, which particularly in chest radiography allows images to be obtained with the same grey scale and darkness. Secondly, as this technique permits digital archiving and visualisation of images on screen, images can be rapidly distributed over a network making them available when and where they are needed.

Natural myocardial markers, or speckles, originated from constructive and destructive interference of ultrasound in the tissues may provide early diagnosis of myocardial changes and be used in the prediction of some cardiac events. Due to its relatively temporal stability, speckles can be tracked by dedicated software along the cardiac cycle, enabling the analysis of the systolic and diastolic function. They are identified by either conventional 2D grey scale and by 3D echo, conferring independence of the insonation angle, thus allowing assessment of cardiac mechanics in the three spatial planes: longitudinal, circumferential, and radial. The purposes of the present paper are: to discuss the role and the meaning of cardiac strain obtained by speckle tracking during the evaluation of cardiac physiology and to discuss clinical applications of this novel echocardiographic technology.

Grey scale median (GSM) measured on ultrasound images of carotid plaques has been used for several years now in research to find the vulnerable plaque. Centres have used different software and also different methods for GSM measurement. This has resulted in a wide range of GSM values and cut-off values for the detection of the vulnerable plaque. The aim of this study was to compare the values obtained with two different softwares, using different standardization methods, for the measurement of GSM on ultrasound images of carotid human plaques. GSM was measured with Adobe Photoshop(®) and with Artery Measurement System (AMS) on duplex ultrasound images of 100 consecutive medium- to large-sized carotid plaques of the Beta-blocker Cholesterol-lowering Asymptomatic Plaque Study (BCAPS). The mean values of GSM were 35·2 ± 19·3 and 55·8 ± 22·5 for Adobe Photoshop(®) and AMS, respectively. Mean difference was 20·45 (95% CI: 19·17-21·73). Although the absolute values of GSM differed, the agreement between the two measurements was good, correlation coefficient 0·95. A chi-square test revealed a kappa value of 0·68 when studying quartiles of GSM. The intra-observer variability was 1·9% for AMS and 2·5% for Adobe Photoshop. The difference between softwares and standardization methods must be taken into consideration when comparing studies. To avoid these problems, researcher should come to a consensus regarding software and standardization method for GSM measurement on ultrasound images of plaque in the arteries.

Doppler tissue imaging (DTI) is a new ultrasonic technique that can be used to give quantified information about the motion of the myocardium. DTI M-mode recordings can be generated that display cardiac wall motion in great detail. In order to verify the motion as displayed in these images comparisons were made with simultaneously obtained grey-scale M-mode recordings. After capturing 135 simultaneous DTI and grey-scale M-mode recordings, those were selected in which wall motion could be accurately assessed from the grey-scale recording. Comparison with the DTI images shows: (1) that DTI accurately displays the direction of wall motion; and (2) that DTI displays whether the wall is thickening or thinning as a velocity distribution across the heart wall. This information is more reliably displayed and easier to interpret in the DTI M-mode recordings than in the grey-scale M-mode recordings.

Background and study aims The aim of this study was to assess the ability of transabdominal ultrasonographic morphologic features and Doppler flow parameters in differentiating benign from malignant bowel lesions. Patients and methods Sixty patients with sonographically detected gastrointestinal lesions and 30 control subjects were prospectively enrolled. Bowel wall thickness; length of the affected segment; the wall layering pattern; the resistive index (RI); pulsatility index (PI); flow volume (FV) of the intramural vessels, the superior mesenteric artery (SMA), and the portal vein (PV) were recorded. The final diagnosis was histopathological. Biopsies were obtained endoscopically, ultrasound-guided, or by surgery. Results Of the patients, 48 proved to be histopathologically malignant and 12 were benign. Malignant bowel lesions were found to have a higher mean wall thickness (a cutoff value of 12.3 mm), more frequent loss of wall layering pattern (88.2% vs. 38.9%), a shorter length of affected segment (11.2 vs. 49.2 cm); P = 0.001. The RI, PI of the intramural vessels and SMA showed no difference between the inflammatory and malignant groups. Ultrasound-guided biopsy was resorted to in 13 patients (21.7%) and it was diagnostic in all of them. Conclusion Ultrasonography is helpful in the characterisation of bowel lesions suggesting their benign or malignant nature. Ultrasound-guided biopsy has certain indications. The Doppler parameters of different pathologies are overlapping and thus are of little help in this regard.

Objective The current study aims to establish whether detection of solitary pulmonary nodules can be improved by inverting the grey scale of posteroanterior (PA) chests. Methods 30 PA chest images were presented on 2 occasions to 16 senior radiologists on either primary or secondary class displays in the standard or inverted mode. 15 images within each group contained a single nodule positioned in a range of anatomical sites. A receiver operating characteristic (ROC) methodology was used to explore differences between the presentation modes. Results Improved ROC scores were evident with inverted (Az 0.77) compared with standard (Az 0.73) (p=0.02) images; however, this difference was seen only with the primary displays. The benefits seen are most likely owing to increased nodule luminance with the inverted images, particularly when using primary displays. Conclusion This study demonstrates that the inverted image can offer advantages in lung nodule detection over the standard presentation mode when images are viewed on high-specification viewing systems. The study has demonstrated that there is an improvement in the detectability of lung nodules on an inverted image with a primary display monitor that is not evident with secondary displays. This is likely to be the result of increased nodule luminance on primary displays when images are presented in the inverted mode.

Objectives: Currently colour flow Duplex examination of the iliac arteries is at best 84–92% sensitive. In an attempt to find a technique to improve on this sensitivity we have studied the effect of Klean Prep, an iso-osmotic bowel preparation, on the Duplex image and Doppler signal obtained when scanning iliac arteries. Methods: Twenty iliac segments in 10 arteriopaths were scanned by a blinded observer, after either starving for 12 h or having Klean Prep bowel preparation. Grey scale image, colour mapping and Doppler signal to noise ratios were scored on a linear analogue system. Each patient was subsequently rescanned after the other method of preparation and was once again scored by a blinded observer. The two sets of scores were then compared. Results: We found significant improvements in the linear analogue scoring of grey scale images, colour mapping and Doppler signal to noise ratios, when using Klean Prep as opposed to starving the patient prescan. Conclusions: Preparing patients with Klean Prep before iliac Duplex examination improves the visualisation of these arteries.

Introduction Aortic valve calcification (AVC), even without haemodynamic significance, may be prognostically import as an expression of generalized atherosclerosis, but techniques for echocardiographic assessment are essentially unexplored. Methods Two-dimensional (2D) echocardiographic recordings (Philips IE33) of the aortic valve in short-axis and long-axis views were performed in 185 consecutive patients within 1 week before surgery for aortic stenosis (n = 109, AS), aortic regurgitation (n = 61, AR), their combination (n = 8) or dilation of the ascending aorta (n = 7). The grey scale mean (GSMn) of the aortic valve in an end-diastolic short-axis still frame was measured. The same frame was scored visually 1–5 as indicating that the aortic valve was normal, thick, or had mild, moderate or severe calcification. The visual echodensity of each leaflet was determined real time applying the same 5-grade scoring system for each leaflet, and the average for the whole valve was calculated. Finally, a similar calcification score for the whole valve based on inspection and palpation by the surgeon was noted. Results Visual assessment of real-time images using the proposed scoring system showed better correlation with the surgical evaluation of the degree of valve calcification (r = 0·83, P

The HSP70 superfamily is a reliable biomarker for hyperthermia, hypothermia and hypoxia. The Enzyme-linked Immunosorbent Assay (ELISA) respectively immunohistochemically staining methods are the typically used techniques for the quantification of those proteins. As the costs for reagents and devices as well as the work schedule of these methods are immense it was the goal of our study to develop an easy and reliable method to quantify the concentration of specific proteins. We established a procedure to measure the relative concentration of proteins fixed on ROTI ® PVDF membranes via Western blot, calculating the relative protein concentration in dependency to the grey scale index of the normalized and digitalized pictures of the bands on the blots.

Objective: The aim of this study was to analyse the microarchitecture of bone in association with implant placement in young ectodermal dysplasia (ED) patients. The general hypothesis was that the structural and morphological features of bone microarchitecture are different between males and females, which may influence clinical outcomes. Materials and Methods: The bone harvesting is not additionally invasive, as the procedure was made at the time and site of implant placement. Twenty one samples (8 female, 13 male) were harvested from nine ED participants whose age ranged between 14 and 21 years and specified by the site of harvesting. Micro-CT analysis at 5 μm resolution was conducted on each sample. Specialized CT analysis of the three-dimensional (3-D) bone microstructure was made to compare structural parameters. In addition, two bone samples (one male, one female) were sent to the University of Michigan and analysed at 9 μm resolution. Results: No significant difference was found between male and female samples. Bone analysis of particular sites revealed that bone-specific surface (BS/BV) was found to be significantly higher in male than in female samples, whilst the mean values of 10 parameters, the grey scale value histograms and 3-D visualization showed that female samples had higher compact density than male samples. Conclusion: Microstructural analyses indicated that female ED bone was more compact and with greater trabecular connectedness than male bone. These features may enhance resistance to external force transfer of mastication compared with male bone. Further bone samples from other jaw bone areas will provide information on whether there are regional differences in jawbone quality and quantity, which may influence implant treatment outcomes, as well as follow-up analyses of treatment outcomes. © 2011 John Wiley & Sons A/S.